JCI Senate Foundation Scholarship Application

This package contains information and directions for applying to the JCI Senate Foundation Scholarship Program. Scholarships will be awarded to graduating high school seniors in South Dakota, who plan to continue their education at accredited post-secondary colleges, universities or vocational schools. They must be used for educational expenses in the first year of full-time study. Checks awarded will be made out in the name of the recipient and the educational institution of their choice.

Eligibility: Graduating high school seniors who are a US citizen and reside in South Dakota.

Applications for the South Dakota JCI Senate Foundation Scholarship will be judged and ranked as 1st place recipient ($250.00 award); 2 nd place recipient ($200.00 award); 3 rd place recipient ($150.00 reward).

Winning recipient applications are eligible for the US JCI Senate Scholarship award of $1000.00. Applications will be forwarded by the SD JCI Senate Scholarship Program Manager.

Applications can be submitted electronically to: Edith Arneson – email address [email protected]

Or

Via USPS to this address : Edith Arneson, Scholarship Program Manager 1000 N. West Ave. Suite 410 Sioux Falls, SD 57104

Instructions for applying for the JCI Senate Foundation Scholarship Please read the following points carefully. Failure to comply will be cause for disqualification.  Submission preference will be in a Microsoft Word compatible format. Typed or neatly hand printed (blue or black ink only) submission will also be accepted. · Included in this application package are all the necessary forms. Your application packet pages must be submitted in order as listed below. Failure to comply will be cause for disqualification. Section 1 Applicant Information Section 2 High School Contacts Section 3 College Information Section 4 Parent or Guardian Information Section 5 Financial Statement Sections 6-8 Leadership Positions & Offices / Memberships / Honors and Awards You may include additional sheets to continue the information for these areas as needed Sections 9 Employment You may include additional sheets to continue the information for these areas as needed Section 10 Personal Statement (100 to 300 words) Section 11 Continuation Pages for section 6-9 (if applicable) Section 12 College or University Acceptance Letter (if applicable) Section 13 Supporting documentation of your choice (awards, certificates, articles, pictures, etc) Section 14 Reference Letters Section 15 Transcripts (grades and state test scores) Section 16 Signature

Form: Scholar-2016-2017  Your personal statement is limited to 300 words. Any more than 300 words will not be judged.  Reference letters are limited to three (3) letters with a maximum length of one (1) page (one side only) each. You will receive credit for each reference letter included. · Your school transcript should be the very last attachment to your application package. · Sign the bottom of the Personal Statement section · Your name must be on the top of each sheet in the package, along with a page number. When using a MS-Word compatible editor, enter you name in the ‘Header’ section. · Each student must have an active, working email address listed. · All materials MUST be submitted under one cover. Materials sent in multiple mailings will NOT be accepted. · Your application must be postmarked no later than January 5, 2018 to the State Scholarship Chairman listed under your state. · Your application will be evaluated by persons outside of your area so do not use acronyms for items such as; clubs, programs, event, or awards where they are not national programs. Where the name of the item is not self explanatory, include a description. Example: REACH or J. Doe Memorial Award, should include a description such as: St. Thomas Methodist REACH program to feed the homeless, J. Doe Memorial Award for Top Female Tennis player. · Do not include these first two pages of instructions in your reply. · By submitting your application you agree that your name may be used as part of the public relations of the US JCI Senate program, the US JCI Senate Foundation and the US Junior Chamber of Commerce and their affiliates such as their associated state programs · To submit your application package: Refer to the website www.usjcisenate.org or www.usjcisenatefoundation.org , under the Scholarship section. Locate the state where you live. The due date is postmarked January 5, 2018. If your state is not listed, you are not eligible. Do not submit the application to any address on the web page except those under the State Scholarship listing section (packages submitted to the wrong address will not be forwarded).

Form: Scholar-2016-2017 Student Name: Page: 1

JCI Senate Foundation Scholarship Application

1. Applicant Information Applicant Name Date of Application

Applicant Home Address Applicant e-mail address

City State Zip Code Phone Number

Are you a U.S. Citizen (check one) Yes No

2. High School Information Name of applicants High School Principal or Counselor Name

Address & City State Zip Code Phone Number

High School E-mail contact

3. College Information Name of College or University you plan to attend

Address City State Zip Code

Have you been accepted to this College or University

Yes (if Yes, attach copy of acceptance letter) No

Form: Scholar-2016-2017 Student Name: Page: 2

4. Parent or Guardian Information Father’s Name Check here if father is deceased

Father’s Home Address Occupation

City State Zip Code Phone Number

Mother’s Name Check here if mother is deceased

Mother’s Home Address Occupation

City State Zip Code Phone Number

Do you have a Step-Parent or Guardian other than your Parents: Yes No If YES, provide the following information Step Parent or Guardian Name

Home Address Occupation

City State Zip Code Phone Number

List in chronological order the names of your brothers, sisters or other persons dependent upon your parents for support Name Age Relationship

Form: Scholar-2016-2017 Student Name: Page: 3

5. Applicant’s Financial Statement Information The financial contribution of the applicant toward their own education is an important consideration in awarding this scholarship. The committee does not wish to penalize those students whose industry and careful planning have been a consideration in planning college attendance. The budget should be based on your first year of education. Your budget does not have to balance. Income 1. Savings to date 1. 2. Expected summer earnings 2. 3. Expected contribution from parents 3. 4. Earnings from part-time work 4. 5. Money from other sources: 5. Include gifts from friends, relatives Education insurance, loans, other Scholarships. Etc. Total Estimated Income

Expenses 1. Tuition and Incidental Fees 1. 2. room and Board 2. 3. Books and Supplies 3. 4. Clothing 4. 5. Incidental Expenses (Travel, Recreation) 5. Total Estimated Expenses

Explain any special personal family or financial situation you believe merits consideration:

Form: Scholar-2016-2017 Student Name: Page: 4

6. Leadership Positions and Offices List by name and by year (9, 10, 11,12) leadership positions and offices held, and the approximate time commitment each month for school, church, community and volunteer activities. Example: School: Student Council President (12; 2.7 hours/month) ; Yearbook Editor (12; 35 hours/month) ; Basketball Captain ( 12; 5 hours/month); Church: Youth Group President (11; 10 hours/month); Community: Hospital Volunteer Coordinator (11, 12 ; 25 hours/month)

7. Memberships List by name and by year memberships and other participation and the approximate time commitment each month for school, church, community and volunteer activities. Example: School: Basketball Team (9, 10, 11; 35 hours/month); Cheerleader (11, 12; 20 hours/month) ; 4-H Club (9, 10, 11, 12: 8 hours/month); Church: Youth Choir (10-12; 4 hours/month); Community: Hospital volunteer (9, 10; 25 hours/month)

8. Honors and Awards List by name and by year the honors and awards you have received during high school. Example: School: 4-H Gardener of the Year (11); Boys/Girls State (11); National Merit Scholar (12) ; National Honor Society (12) Church: Perfect Attendance (9); Community: Hospital Volunteer of the Year (11)

Form: Scholar-2016-2017 Student Name: Page: 5

9. Employment List the names and addresses of employers, including family business or self-employment. Indicate whether you worked part-time, during the summer, or full-time: and include the hours you worked on a monthly basis. Example: Mowing Lawns – Summer – 100 hrs. total (9); Wal-Mart – Part-time – 80 hrs. (10); Family Farm – Full-time – 160-hrs (11-12)

Form: Scholar-2016-2017 Student Name: Page: 6

10. Personal Statement Write (type or print) a paragraph of 100 to 300 words maximum, indicating your chosen field of college study. State your reasons for this choice. Include pertinent experiences, activities and accomplishments.

Sections 11-15 shows the order to list your attached documents. Ensure to sign section 16 11. Continuation Pages from section 6-9 (if applicable) 12. College or University Acceptance letter (if applicable) 13. Supporting documentation of your choice (awards, certificates, articles, pictures, etc.) 14. References Letters You may include up to three (3) letters of reference from educators, clergy, employers, and/or community leaders. References should be attached to this application. You will receive credit for each reference letter included. 15. Transcripts A copy of your current high school transcript MUST be included. This MUST include class scores and state test scores (state test scores are not required if home schooled). If you are taking college classes, include those as well. 16. Signature I certify that the facts contained in this scholarship application are true and correct. The United States JCI Senate Foundation is hereby authorized to verify any information contained in this application. I understand that any falsification of misrepresentation will result in disqualification. Signature of applicant Date Signed

Staple all pages together in the upper left-hand corner. Be sure you include all references and other attachments. Each page of your application MUST list your name and list the page number in the upper right-hand corner. Remember to sign the application package (above)

To submit your application package:

Refer to the website www.usjcisenate.org or www.usjcisenatefoundation.org , under the

Form: Scholar-2016-2017 Student Name: Page: 7

Scholarship section. Locate the state and submission address of the state you live. If your state is not listed you are not eligible. Do not submit the application to any address on the web page except those under the State Scholarship listing section (packages submitted to the wrong address will not be forwarded).

Form: Scholar-2016-2017